腹腔镜手术联合促性腺激素释放激素激动剂治疗子宫内膜异位症的临床效果

Clinical effect of laparoscopic surgery combined with gonadotropin - releasing hormone agonist in the treatment of endometriosis

目的探讨腹腔镜手术联合促性腺激素释放激素激动剂（GnRH-a）治疗子宫内膜异位症（EMs）的临床疗效。方法将2013年2月至2015年2月交城县人民医院收治的86例EMs患者选为研究病例，采用随机数字表法将其分为两组，对照组43例采取腹腔镜手术治疗，观察组43例在腹腔镜手术治疗基础上联合应用GnRH-a治疗，分析临床治疗效果。结果观察组总有效率为93．02％，显著高于对照组的72．09％，而术后复发率为11．63％，显著低于对照组的32．56％，组间差异均有统计学意义（x2=7．55、8．41，均P〈0．05）。治疗后观察组卵泡刺激素（1．71±0．64）U／L、黄体生成素（2．66±0．75）U／L及雌二醇（96．72±14．51）pmol／L水平均较治疗前明显降低（t=8．80、7．80、7．55，均P〈0．05），且与对照组差异有统计学意义（t=8．55、7．48、7．19，均P〈0．05）。观察组有妊娠要求患者总妊娠率70．59％，显著高于对照组（38．71％），差异有统计学意义（x。=7．77，P〈0．05）。观察组性交后疼痛缓解率90．70％、痛经缓解率86．05％及慢性盆腔疼痛缓解率93．02％均明显高于对照组，差异均有统计学意义（x2=6．55、7．01、7．88，均P〈0．05）。观察组不良反应发生率为11．63％，明显低于对照组（27．91％），差异有统计学意义（x2=7．06，P〈0．05）。两组不良反应主要为潮热多汗、阴道干燥、失眠、乏力等低雌激素症状，均可I冀耐受，经停药处理后缓解或消失，肝肾功能检查未见异常。结论腹腔镜手术联合GnRH-a治疗EMs能提高治疗效果，改善患者的症状和生殖激素水平，提高术后妊娠率，降低术后复发率，且安全性较高，值得临床推广和应用。

Objective To investigate the clinical efficacy of laparoscopic surgery combined with gonadotropin - releasing hormone agonist （ GnRH - a） in the treatment of endometriosis （EMs）. Methods 86 patients with EMs were selected as study subjects. The patients were divided into two groups by random number table. 43 patients in the control group underwent laparoscopic surgery ,while 43 patients in the observation grouop received GnRH -a treatment based on laparoscopic surgery,and the clinical effect was analyzed. Results The total effective rate was 93.02% in the observation group,which was significantly higher thari 72.09% in the control group. The recurrence rate in the observation group was 11.63% ,which was significantly lower than 32.56% in the control group, the difference was statistically significant （ X2 = 7.55,8.41, all P 〈 0. 05 ）. After treatment, the levels of FSH, LH, and E2 of the observation group were （ 1.71 ± 0.64） U/L, （2.66 ±0.75 ） U/L, （96.72 ±14.51 ） pmol/L, respectively,which were significantly lower than before treatment （ t = 8.80,7.80,7.55, all P 〈 0. 05 ）, and the differences were statistically significant compared with the control group （ t = 8.55,7.48,7.19, all P 〈 0.05 ）. The total pregnancy rate of the observation group was 70.59% ,which was significantly higher than 38.71% of the control group, the difference was statistically significant （ X2 = 7.77, P 〈 0.05 ）. The pain relief rate, dysmenorrhea rate, remission rate of chronic pelvic pain in the observation group were 90.70% ,86.05% ,93.02%, which were significantly higher than those in the control group （X2 = 6. 55,7.01,7.88, all P 〈 0. 05 ）. The incidence rate of adverse reactions in the observation group was 11.63% ,which was significantly lower than 27.91% in the control group, the difference was statistically significant （ X2 = 7.06, P 〈 0.05 ）. The main adverse reactions were hot flashes sweating, vaginal dryness, insomnia, fatigue and other low estrogen symptoms, which could tolerate, after treatment to relieve or disappear, liver and kidney function tests had no abnormalities. Condusion Laparoscopic surgery combined with GnRH - a in the treatment of endometriosiscan improve the treatment effect, improve the symptoms and reproductive hormone levels, improve the postoperative pregnancy rate, reduce the recurrence rate, and with high safety, it is worthy of clinical promotion and application.